CTICasesKaposi Sarcoma with Multicentric Castleman Disease in an HIV Patient
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Imaging findings
A 21-year-old HIV-positive male, two months after starting antiretroviral therapy, developed peritracheal thickening and palpable lymphadenopathy. CT showed bulky axillary and mediastinal lymphadenopathy with splenomegaly. Biopsy revealed spindle cells with vascular channels consistent with Kaposi sarcoma, along with angiophollicular changes characteristic of multicentric Castleman disease.
Key takeaways
Immune reconstitution inflammatory syndrome (IRIS) can occur in HIV patients after initiating antiretroviral therapy, often presenting with paradoxical worsening of pre-existing or subclinical infections. However, the presence of Kaposi sarcoma and multicentric Castleman disease (both HHV-8 associated lymphoproliferative disorders) highlights the complexity in this population. It's unusual for Kaposi sarcoma to progress while on effective ART, necessitating biopsy for definitive diagnosis.
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